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How to understand and work with Risk as an Aspiring Psychologist
Episode 17 • 4th April 2022 • The Aspiring Psychologist Podcast • Dr Marianne Trent
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Show Notes for The Aspiring Psychologist Podcast Episode: 17

Thank you for listening to the Aspiring Psychologist Podcast.

Today we focus on ways to understand and work with people who might pose a risk to themselves or others. This is important stuff and crops up in all manner of services. 

The Highlights:

  • 00:00: Content warning
  • 00:59: Welcome & Making Special Requests
  • 02:08: Content of the episode: Risk to self or others
  • 03:09: Defining Risk for the episode
  • 04:25: Service information
  • 05:31: Confidentiality and consent
  • 07:07: Time frames and context
  • 09:09: Pressure and tone of responses
  • 10:46: Feeling contained
  • 12:44: Max
  • 14:32: British Transport Police
  • 16:44: Using your diary for emergency contacts
  • 17:46: Measuring risk
  • 18:57: Reducing risk over time
  • 19:59: Keep safe plan and care plans
  • 21:00: Clinical Records
  • 21:58: Does self-harm always mean suicidality?
  • 22:54: Learning stabilisation skills
  • 23:50: This stuff matters!
  • 24:54: The compassionate Q&A replays
  • 25:52: The Upcoming aspiring psychologist collective book
  • 26:37: Compassionate Q&A info

Links:

If you have information about someone being a risk to themselves or others on a railway track the current advice is to call 999.

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Transcripts

I just wanted to start today's podcast episode by just giving you a little warning that it is going to cover risk. It's going to cover examples of how someone might pose a risk to themselves or to others. If you might find this triggering, then please take my permission and give yourself permission to listen to this at a time where you feel more robust and able to, um, to engage with the content.

00:59:

Hi, welcome along to the aspiring psychologist podcast cast. Thank you for listening. And I hope you'll find today's episode really useful. This is another special request episode today, um, and you can make any special request you might have, um, for topics for the podcast by heading to my website, good thinking psychology.co.uk/podcast. And then there at the top of the page is information, um, for how you can submit any requests that you might have please do. Um, because I want this to be super useful for you. Um, and yeah, I want this to be user led as well as just being generated by me because, you know, knowing that you are recognizing that I might have some useful stuff to teach you and you reaching out to me to ask, uh, ask for me to teach it to you is just, uh, the most incredible feeling. So, yeah, thank you very much. Um, for all of the feed that I've had and for continuing to listen, um, it means a great deal,

02:08:

Just a little caveat, um, before we begin to let you know that the risk I will be talking about is when someone is, uh, discussing perhaps risk for themselves or someone else, but don't worry if you want some more info on practical risk management, um, because that is coming up soon in an interview, um, I'll be doing with a psychiatrist where we discuss, um, how to kind of optimally prepare the environment and factors to consider about minimizing risk to yourself, um, to colleagues and to, to, it's also worth saying that when working with risk, it's really important to work collaboratively with your multidisciplinary team. Um, and of course with, uh, psychiatry and with supervisors, um, and anybody else you might have on board as part of your team. So do do take my advice in conjunction with your own best practice guidelines.

03:09:

Okay. So no matter what area of psychology you are wanting to work in, it is likely that you encounter risk and working with risk as you progress throughout your career. Um, it's certainly something that crops up for me daily in clinical practice, even if just to discuss it, um, you know, whether it's a current thing clients or not. Now, of course, when we're working in, um, in services, risk can look like risk to themselves. Risk can look like risk to others. Um, it's not really the done thing to define, to define a word by using the word, is it, so let me define risk without using the word risk. Okay. So risk might look like someone who wants to, um, self-harm. It might look like, uh, self-harm that is superficial. It might look like self-harm that is more significant. It might involve, that they have, um, you know, perhaps a plan to end their own life.

04:25:

Um, you may also be party to information where they're saying that they want to harm someone else, and that might be in a forensic service, um, or it might be that you, um, suspect that you are having some sort of psychotic episode, um, or some sort of change. So it might be that people are in, you know, perfect lucid thought telling you that they think, you know, so, so and so is going to, you know, be hurt. Um, and that of course is, is a significant event that needs to be recorded and needs to be handled, um, with the client at the time. Um, so yeah, you might handle that in a number of different ways. If you haven't already listened to episode eight of the aspiring psychologist podcast, then it might be useful for you to do that either before you listening to this episode or, um, after, um, so episode eight is all about boundary setting, um, as an aspiring psychologist.

05:31:

And in that I go through, um, you know, confidentiality and consent, um, and that is also really useful stuff, um, to draw upon. So I'm not gonna go over all of that content again, because I don't want to, you know, duplicate what I've already said, because you won't find that that useful, but I will, I will pay lip service to what I've said, but you might well find it helpful to listen to episode eight if you haven't already, because that is going to be a more full account, um, of what we are talking about, um, here, um, with respect to confidentiality and consent. So, um, as you'll know, um, when we are working with people, we've already gone through our confidentiality and consent, um, and that is especially useful when you then get issues where risk is cropping up. So if someone were to say that they, you know, wanted to hurt themselves or someone else, then you will then obviously respond appropriately in the moment. Um, also think with them about your, you know, your needing to keep themselves and others safe and that they're aware, um, that you have that duty of care to do that. You've got that clinical responsibility that you've got to look after everybody, um, to keep them safe. It's a big job guys. It's a big job is take a bone, take a moment, take a breath.

07:07::

It is a big job and it matters and what you are doing matters. Um, but we are here, we're in the moment and the client has suggested that they want to, to hurt themselves or so else it can be useful, um, to think about timeframe. Um, it can be useful. Um, so for example, someone has said that they, you know, they've got a plan to end their own life, then it can be useful to think about, well, have you, have you got a timeframe for that? Is that something that you've know you've got, um, set in mind for a particular time or a particular date and they might well tell you, or they might well not. Um, and when people are less wanting to share information, then it's, it's more worrying. Um, it can be more worrying. Obviously this is gonna be a case case example, and you will definitely need to access supervision of your own about this.

08:06:

So please don't just use this advice to formulate, um, your plans, but it can be in mind and especially if you're not yet in clinical practice, it can be useful for you to think about, well, what would I do? Um, what might I do? How could I handle that? So that's my little caveat. Um, this is a guide, um, but you will obviously need to follow your own protocols and procedures, um, and check in with your management and your supervisors. So someone has told you that they've got a plan. Um, they perhaps won't share with you, um, what timeframe it's going to be, but maybe they have shared with you the method and it's, you know, detailed enough that that feels worrying. You know, that feels scary. Um, and it might be that if it involves harm to someone else that they've shared with you details about what that might involve and what kind of timeframe that might take as well.

09:09:

And, you know, it's, it's tricky because you are gonna be feeling all kind kinds of things going on. You're gonna be feeling, you know, pressure. You're gonna be feeling, um, you know, the importance and the significance of getting this right. Um, when I was an aspiring psychologist, um, certainly sometimes when I was even working as a trainee psychologist, if somebody told me, um, that they wanted to, to end their life, then there might have been a tendency or a desire to run out of the room as soon as possible and kind of get psychiatry involved. Um, but actually we need to think about how that feels as a client communicating this painful information. And actually what can be really useful is to work through with the client, um, you know, what they're thinking and what they're feeling, exploring a little bit about what might have contributed to the way they're feeling and why, um, really try to help contain, um, the person you are speaking to so that they feel like they have shared something with you that then feels safe, is not left them feeling over vulnerable or overstretched, um, how you respond and when you, and with what flavour and tone of compassion and warmth and empathy and positive regard really does matter.

10:46:

Um, you know, if we are to run out of the room, when someone tells us something like that, then it might actually lead the client to feeling that their problems are to you big to cope with, um, or that they, it might lead to them feeling even more, you know, unsafe or, you know, less contained. And when people are not contained, you know, what we know is that they're going to be acting from more from a point of, um, you know, the red area of their window of tolerance. They're not going to be able to engage their soothing and calming thoughts. You know, they're gonna be all out of whack. Um, and you know, logical thought with compassion on their side is not going to be, you know, firing. Okay. So what we are wanting to do is we are wanting to help the client feel heard, seen valid, important. We don't want to be running away. We're gonna break for a quick break here, and I'll be back afterwards to talk with you more about how we can recognize and work with risk as aspiring psychologists.

12:44:

Hi, I'm max and I works as an assistant psychologist in the learning disability service in west Yorkshire. Like most people working in psychologists I'm slowly but surely working myself up to that seemingly impossible goal of getting onto the clinical doctorate with that end goal in mind, I thought I'd have a look at what's out there and see what books might be helpful for this. I came across Marion's book, the clinical psychologist collective and decided that this would be a great buy for me to help me on journey. I found Marion's book really informative. Most insightful. I especially liked how the story reassured me that you don't need to be academically perfect to become a psychologist. And that as long as you have good interpersonal skills, such as compassion and empathy, you will get there. I would highly recommend this book to all aspiring psychologists and also those who want to know a bit more about the world of clinical psychology, and maybe want to work in that field one day,

14:32:

Okay. Welcome back. Um, so before we, um, broke, we were thinking about what risk is, what it might look like, what it might involve and how we can try to optimally respond. Um, it's important that you are able to get information, um, about, about what people are telling you, um, because it might be that you need to communicate that accurately to other services as well. It might be that you are going to need to summon an ambulance, or you are going to need to summon police, um, coast guard. You know, it might be that you need to call, um, the railways, uh, emergency line. Um, is it transport police? I think it's transport police, but, um, a quick Google will reveal who the right people to, um, contact are. I believe there's a specific, um, telephone line for if someone has suggested that they are to attempt to end their own life on the railway.

15:34:

And what I will do is I will try and dig that out and put that in the show notes for you. Um, when I was working in the NHS, we were given like a little card, um, to have all our keys, um, which gave the number, but it snapped off. And so I don't have it anymore, but there is a specific number, um, that you can call. So I will try my best to get hold of that. Um, yeah. Pop it in your diary, um, because it might be really useful. So I have always, when working in, um, clinical roles at the front of my diary, I have had important numbers, um, including the crisis team, including Samaritans, including, um, you know, numbers such as, you know, transport police and, you know, any relevant people in your area that help in crisis situations, because it really could make the difference if you have mean to Scrabble around and look for a number, um, in a moment where actually there isn't much time, it's much better to be able to open up your diary, get to where you need to be and respond.

16:44:

So take a little bit of moments, especially if you are, um, setting up a new diary for the year or you are setting up in a new role, know, get a little bit of an idea of what do I do if the worst happens, what do I do if something happens, that means that I need to take immediate safeguarding actions. So it might be that you've got your local adult or, um, child safeguarding, um, contact details in your important phone number section. They would be very useful ones for you to have, um, indeed. So yeah, a little bit of time in advance of when you're gonna need this information is absolutely time well spent. In my opinion, when we are, um, getting to know clients, it can be useful to think about screening for risks. So there are of course specific screening measures that you can use.

17:46:

Um, I tend to, when it's generic, just use, um, the core outcome measure, um, because it does screen for risk and it will tell you whether someone is clinically significant for risk or not. So that's a really useful place to start, but of course, things like the, um, the GAD-7 PHQ-9, they also green a little bit for risk as well. Um, but yeah, it's an idea to monitor risk. Um, so, you know, it can be useful to do before, during and after measures. Um, so your, before might happen, um, at assessment, your, during, uh, might happen, um, you know, at the point that you start therapy or mid therapy, and then depending on how long your intervention is, um, you might want to repeat those measures as well, and then obviously have measures again at the close. But what we'd be hoping for is that with whatever brilliant work that you and your team are doing, that their wellbeing improves their problems, decrease their functioning, their functioning, um, gets better.

18:57:

And of course their risk decreases, um, that is, you know, the gold standard for what I would think of as a piece of work well done, indeed. And of course, you know, what we've covered in the boundary setting episode of the podcast is, well, what happens if it's only really after you have the session that you, you know, your, your cogs start worrying or you piece together something that you hadn't really picked up on in the session, or you suddenly think, well, actually now I've discussed that with my supervisor. That does feel a lot riskier than I felt it was at the time. You know, what do we do then? Um, and it might be that you are needing to, um, access safeguarding or refer to safeguarding or activate, you know, a keep safe plan, um, without getting hold of the client. If in fact you haven't been able to get hold of them.

19:59:

And if you haven't been able to get hold of them, that's further evidence that we need to put our keep safe plan in place. Now, most services that I am aware of ought to have care plans. Uh, so it's hopefully something that you are familiar with. Um, and it might be something that all of your multidisciplinary team feed into as well. Um, so that there might be care planning elements from psychiatry. There might be care planning elements from, um, from care coordinator, um, or from, you know, occupation therapy, for example. Um, and you might well be able to feed into that as well with any work that you've been doing. Um, so care planning is where we are getting a sense of what might be useful and how we're going to achieve that. But elements of risk would be covered there as well. And in your individual trust or environment, there will likely be risk screening tools and risk screening measures that go into the care planning process.

21:00:

So, um, trying to think what the name of my clinical notes software I was called in the NHS, it was either EPEX or Lorenzo and I can't for the life of me. I think it was EEX the most recent one, um, sad just under a year ago, you know, fallen straight out of my head. Was it care notes? I think it was care notes. So yeah, I think there's three different Genesis there of EPEX Lorenzo and care notes, and I've also used Rio as well, but these clinical notes systems will often have, um, you know, ways to, to specifically screen for and manage risks. So do check out your organisational practices as well. But so to summarize, you know, what we've done days podcast episode is we've thought about risk to selves risk to others, um, and ways to manage record and monitor that risk.

21:58:

Um, it's also useful to think about whether self-harm always means, you know, suicide. And when we're working with, um, adolescent population and where we're working with parents of adolescents, sometimes it can be helpful to just separate those two actions a little bit. So if you've got, um, a young person who's cutting, for example, but cutting in a superficial way, then it doesn't always necessarily equate that that client is suicide door. So sometimes it can be useful to, you know, with the client's consent, share that with the family, you know, actually the client, the client has told me, or, you know, you might, you might, um, I've sometimes fed that back with a young person in the room at the same time as their parent. Um, actually, you know, so, and so is not suicidal. They're not suicidal, but they are feeling, um, you know, a bit lost or a bit wobbly.

22:54:

And they're finding that this helps them have some control at the moment. And of course, what we want to do is move towards being able to learn skills, um, to, you know, ameliorate this distress, you know, so that they can have control in different ways. So, you know, sometimes having that conversation with people can be useful. And of course, what we know is that people who do self-harm are more likely to go on to have, um, you know, suicidal thoughts or, um, intentions, but it's not always the case. Um, so, you know, we can't resting on our laurels here and guaranteeing that, you know, that someone is not going to become suicidal, but currently at the point of assessment, um, if that is indeed what you are assessing, um, it looks like there is no suicidal intent currently, oh, people, this is big stuff, isn't it?

23:50:

This is important stuff. And you are out there doing this work, or you will be in future and it matters, you know, it matters to matters to you. It matters to clients that you may be working with. Currently. It matters to clients who you may not even have met yet. It matters to clients who may be out there living their best life right now. Um, but when they need you, you will be there. Um, and you will have that theory and practice ready to roll, um, to help make that difference. And that is so incredible. Um, well done to you. Um, and thank you for listening to this episode. I hope you find it useful. Like I said, it was a special request. So if you've got any special requests of your own, then do go and check out the, a podcast section of my website, good thinking, psychology.co.uk/podcast to submit your special requests.

24:54:

I hope you find, uh, the upcoming information on the compassionate Q&A, you can watch, um, depending on when you're listening to this, uh, you can definitely watch the first one. And by the time this comes out, you, you might well be able to watch the second one on replay as well. The easiest way to do that is by heading to good thinking psychological services on YouTube whilst you're there be rude, not to, you might as well like, and subscribe, you know, subscribe to the channel, like all the videos, fling a few comments in, um, it would be so welcome. Thank you for listening. And I hope you find the content useful. I look forward to catching up with you next week. Don't forget that new episodes land at 6:00 AM on a Monday UK time. Um, so subscribe via your podcast channels, and that's when they'll drop into your podcast library, or just go searching for the, at 6:00 AM on a Monday, uh, and be hot off the press.

25:52:

Um, take care, have a lovely day, whatever you are up to. Um, and again, thank you for being part of my world. Thank you again for being part of my world and for listening right to the end. We've just got a little bit coming up about the compassionate Q and a C is, and then you can enjoy the jingle take care. And like I said, if you'd like to get involved with, um, your own story for the aspiring psychologist collective, then do check out the details in the, um, show notes for how you can rest request more information. But if you head to my, um, website, which is good thinking, psychology.co.uk, um, and then head to my books, there will be information there for you

26:37:

Being well supported during any interview season is so important. I have therefore, uh, planned some compassionate question and answer support sessions for you. You are absolutely welcome to come along to all of them. Some of them, none of them, no need to book. And here are the dates for you Monday, the 28th of February from 7:30 PM, Monday the 21st of March 7:30 PM, Monday the 4th of April 7:30 PM. And Monday the 9th of May 7:30 PM. And they will all be live streaming via my socials, uh, which includes Twitter, you YouTube, LinkedIn, and Facebook. So you can absolutely pick your favourite, um, platform. And they'll all be available on replay as well. Hope you find it so useful. And I will look forward to catching up with some of you, then take care

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